Tonight, in Toledo, Promedica, Toledo’s main hospital system that practically owns the town, is having a mental health fundraiser ball, called Unmasked. Only those under the age of 40 are welcome. The tickets for 41 and older cost $150 more, so of course the older age group is discouraged. And as if the price isn’t enough of a put down, Promedica goes as far as saying the tickets for the younger adults are only $100 because they want to bring in a fresh perspective.
Toledo is backwards when it comes to mental health, or any health. They lie about the availability of primary care doctors — that’s a given. When it comes to mental health care, suffice it to say that it looks just like that photo on the right.
Here’s a fresh perspective — how about they build a mental health urgent care center, much like any other medical urgent care center?
Just an idea, but I’m not invited to the party — the public party put on by a public institution — because I don’t fit into the demographic that they think fresh perspectives come from. But Promedica doesn’t want our wisdom and experience, or anybody’s “fresh perspective” for that matter, because they’ve got it all figured out already.
For example, Promedica hospital closed the psychiatric units in Lenawee County this summer.
The bright idea that came out of the fundraiser, I heard on the news tonight, is that most of the money will go to a home for treating pregnant women addicted to opioids.
But wait — wasn’t this party’s theme, Unmasking Mental Illness? But the money is going for opioid addiction instead. Could it be they don’t understand the difference?
So now the best way for Toledo’s seriously mentally ill to obtain treatment is if they are also addicted to opioids. But believe it or not, many are not addicts. If they are pregnant and taking drugs, then all the better, but the odds are against that as well.
What about the men and the women who are not “with child,” who are not addicted to opioids, but who are seriously mentally ill? And maybe they are even over 40! They aren’t on the radar for the “fresh perspective” 40 and under crowd with their one-track minds — having babies and taking drugs.
Think about it. The mental health money raised at their party tonight seems to be going to their own age group, strictly their generation, for addiction, not for plain old mental illness.
It’s always been sort of hopeless in Toledo — there’s not a lot to go around — but now it feels seriously unsafe to be over 40 in this town, when the selfish, myopic young’ns are running the show and keeping it all for themselves.
Ohio has a golden opportunity to lower drug prices this November.
I’m voting Yes on Issue 2, even after seeing all the “No” ads that the drug companies run warning of dire consequences if we dare to demand that we should pay the same for drugs that the Veterans Administration pays.
As if drug companies can hold our health hostage and demand outrageous ransoms for its release. If that is truly so, then only the richest people will ultimately be able to pay, and the rest of us will be out of luck. And there are such things as consumer laws. We aren’t really going let that happen, are we?
Regardless of all that pressure from drug companies and deceptive TV ads that outnumber the “Yes” TV ads by ten to one – ads that indoctrinate us with dread and fear – I’m still voting yes, because drugs cost too much.
With money to burn, drug companies dominate our nightly dinnertime news hour with ads for very expensive drugs that hardly anyone needs and only a few can afford. As if we don’t have doctors who we consult to treat our illnesses. Since when do drug companies prescribe drugs; it is a conflict of interest, immensely greedy, intrusive, and highly unnecessary.
Having to pay multiple times the price paid in Europe for the same prescription drugs is a shameful social travesty and a betrayal of public trust. Yet we’ve been standing aside while they make huge profits and waste our healthcare dollars.
I’m voting Yes on Issue 2, so that taxpayers can save an estimated $400 million per year on state-bought drugs alone. The state of Ohio is a huge pharmaceutical buyer and we deserve the same price that the Veterans Administration pays.
If Issue 2 wins, then other states will follow suit, and insurance plans will also demand the same price, and we will shave billions of dollars off the unsustainably high cost of healthcare in this country today.
But what I look forward to most of all, is when the huge pharmaceutical lobby pool dries up.
Wouldn’t it be great if We The People could get our elected representatives back?
Thank you, Representative Teresa Fedor, for endorsing Issue 2.
New for 2018, Marketplace rates for children will rise 20% to 53%, on top of the additional average 20%-30% rate increase insurers in Ohio demand in 2018.
Child rates in the past they have always been 63.5% of the adult base rate until the age of 21. Next year, 0-14 will be 76.5% of the adult base rate, with ages 15 to 20 being 83.3% to 97% of the adult base rate.
2018. We all know how it’s going. We are supposed to feel lucky that we can at least still buy health insurance. And after what we witnessed in Congress this year, and how it could have gone, but for one vote, we know we’re damn lucky.
We were warned that rates would go through the roof this year. That’s due to the uncertainty of the government reimbursing insurers for CSRs, the uncertainty over the insurance requirement mandate, the uncertainty of a repeal, as well as the totally understandable (not), predictable, ever-rising, unsustainable, runaway medical and non-negotiable pharmaceutical cost factors, that alone amount to a 7% rate increase in 2018, along with the resumption of the ACA tax on premiums that was halted last year, and some increases in administration costs. We are braced for rates to going up 20 to 40% or more. Hands above our heads, they got us, we’ll pay!
But at least the ACA, warts and all, has survived the Congressional guillotine, and most of the 6% of the U.S. population that comprises the individual insurance market is certainly grateful for another year of being able to buy health insurance.
But what a sneaky thing the child age rating hike is, which raises the rates for all children under the age of 21 by 20% to 53%. CMS snuck that in on December 16, 2016, just after Trump was elected. That, on top of all the “uncertainty,” the rising medical costs blah blah blah, 2018 is going to be a real doozy.
Which is why a typical family may see a rate hike of 29% for themselves, and 71% for their children.
Take your typical Ohio family – say, John and Pam, who are 55. They have two kids who are 17 and 20. John is an independent contractor and earns $78,000. Pam is an adjunct university professor and earns $21,000. Together they make $99,000 before taxes, just over the 400% Federal Poverty Level that would qualify them for a health insurance subsidy. Their net income after taxes is $78,000.
Toledo, Ohio is a closed town when it comes to doctors accepting new patients. When it became too costly in 2016, John and Pam had to give up their Medical Mutual PPO insurance and hence their ProMedica doctors that they had been going to for 20 years. Molina was one of the cheapest insurance plans they could buy. But they had to find new doctors, because their long-time doctors didn’t accept Molina insurance.
Mercy doctors were in the Molina network, and they were not as closed as ProMedica doctors. That’s why they chose Molina over CareSource, another cheap plan, but one with a 90% inaccurate provider network, a network that supposedly included ProMedica doctors, but not really. (ProMedica, when last checked, had only one primary care family practice doctor accepting new patients, but you’d have to call back in a month to schedule an appointment, which supposedly would be scheduled for three months after that.*)
If they had made just two thousand dollars less (see Kaiser subsidy calculator here), John and Pam would have qualified for a $3,334 subsidy this year (undoubtably it would be more than $6,000 in 2018 because the SLCSP which is tied to the subsidy may be 20-30% more, in tandem with the rest of the plans; see rate increases below.) The subsidy would have reduced their health insurance premiums to 10% of their gross income for a silver plan, but alas, they make too much money to qualify.
John and Pam chose a gold plan with a lower deductible because they couldn’t afford the risk, just in case, of having to come up with $7,500+ to meet the deductible before the insurance would kick in.
As it was, in 2016 John and Pam paid 22% of their net income on health insurance, $17,448, at $1,454/month. It was a lot more than they were paying just a few years before. An affordable and reasonable percentage, in keeping with the spirit of the ACA, would be 13% of their take-home, or 10% of their gross. John and Pam make more money than most families in Toledo, but to have 22% of their net income going to pay for health insurance really hurts.
In 2016, John and Pam’s rates were $554.50 each per month, and the kids’ rates were $172.62 each.
But next year, in 2018, John and Pam’s health insurance will go up 39%! It will surpass housing as biggest chunk of their budget, becoming a whopping 31% of their take-home income, $24,240 for the year; $2,040/month. The astronomical but necessary expense squeezes out any money that could ever have been saved for retirement, which they need to fund, and eliminates any possible budget they may have hoped for to help their kids with higher education expenses.
click to see 2016 and 2018 Molina rates
WhileJohn and Pam’s health insurance is going up 29%, health insurance for their kids goes up 71%. The family’s health insurance premiums next year will cost $6,792 more than last year!
In the midst of uncertainty and rising medical and unnegotiable pharmaceutical cost factors, what a sneaky rate hike this children’s age rating hike is, and what a scary thing it is for families like John and Pam’s. Thanks, elected officials, for looking out for our best interests. Maybe it’s time to stop the killing and let everyone in on Medicare, expanded and improved.
Medical Mutual PPO, United Healthcare, Anthem and Aetna have flown the coup. Also gone is HealthSpan and InHealth, the failed co-op.
Anthem is actually continuing in one tiny, rural county in southern Ohio, with just a few people, just so Anthem can stay in the game, if you call those fair rules, just in case it wants to jump back in, in the next five years. Aren’t they clever at the expense of the public good. But since healthcare is not considered a public good, they can make profit over people all day long, and into the next decade, until they’ve squeezed it dry.
Since all five insurers’ prices are going up about the same, people who receive a subsidy may come out somewhat unscathed. Ironically, the government that caused the uncertainty that led to the increases will be funding the increases via the subsidies. If only the government would take that money that they throw at a multitude of greedy, demanding insurance companies, and allocate it to an expanded and improved Medicare for All, we’d have a pretty nice single-payer system in the U.S., which would go a long way to stimulate our economy. The structure is already in place, and so is the money.
Too bad for the 30% like John and Pam who don’t get a subsidy; their health insurance expense is simply unsustainable. They may have to keep working into their seventies, because there’s no way they can save money for retirement when the insurer gets every red cent.
Four of the five babies in the photo are crying, because they just can’t get enough money. They realize that only one with a certain je ne sais quoi will win in the end.
We have a miserable rotten, broken healthcare system, and our leaders really dug in this year to make it even worse than that. If we want to survive as a nation, we will eventually have single-payer, as it has been proven to work well in the rest of the civilized world. But apparently not before a lot of greedy pockets are lined and the corporate for-profit ravens pick every last bit of flesh there can be, all the way down to the bone.
Be it enacted by the People of the State of Ohio that the following chapter and section are added to Title 1 of the Revised Code.
Chapter 194: Drug Price Relief
This Act shall be known as “The Ohio Drug Price Relief Act” (the “Act”).
(B) Findings and Declarations.
The People of the State of Ohio hereby find and declare all of the following:
(1) Prescription drug costs have been, and continue to be, one of the greatest drivers of rising health care costs in Ohio.
(2) Nationally, prescription drug spending increased more than 800 percent between 1990 and 2013, making it one of the fastest growing segments of health care.
(3) Spending on specialty medications, such as those used to treat HIV/AIDS, Hepatitis C, and cancers, are rising faster than other types of medications. In 2014 alone, total spending on specialty medications increased by more than 23 percent.
(4) The pharmaceutical industry’s practice of charging inflated drug prices has resulted in pharmaceutical company profits exceeding those of even the oil and investment banking industries.
(5) Inflated drug pricing has led to drug companies lavishing excessive pay on their executives.
(6) Excessively priced drugs continue to be an unnecessary burden on Ohio taxpayers that ultimately results in cuts to health care services and providers for people in need.
(7) Although Ohio has engaged in efforts to reduce prescription drug costs through rebates, drug manufacturers are still able to charge the State more than other government payers for the same medications, resulting in a dramatic imbalance that must be rectified.
(8) If Ohio is able to pay the same prices for prescription drugs as the amounts paid by the United States Department of Veterans Affairs, it would result in significant savings to Ohio and its taxpayers. This Act is necessary and appropriate to address these public concerns.
(C) Purposes and Intent.
The People of the State of Ohio hereby declare the following purposes and intent in enacting this Act:
(1) To enable the State of Ohio to pay the same prices for prescription drugs as the prices paid by the United States Department of Veterans Affairs, thus rectifying the imbalance among government payers.
(2) To enable significant cost savings to Ohio and its taxpayers for prescription drugs, thus helping to stem the tide of rising health care costs in Ohio.
(3) To provide for the Act’s proper legal defense should it be adopted and thereafter challenged in court.
(D) Drug Pricing.
(1) Notwithstanding any other provision of law and insofar as may be permissible under federal law, neither the State of Ohio, nor any state department, agency or other state entity, including, but not limited to, the Ohio Department of Aging, the Ohio Department of Health, the Ohio Department of Insurance, the Ohio Department of Jobs and Family Services, and the Ohio Department of Medicaid, shall enter into any agreement with the manufacturer of any drug for the purchase of a prescribed drug or agree to pay, directly or indirectly, for a prescribed drug, unless the net cost of the drug, inclusive of cash discounts, free goods, volume discounts, rebates, or any other discounts or credits, as determined by the purchasing department, agency or entity, is the same as or less than the lowest price paid for the same drug by the United States Department of Veterans Affairs.
(2) The price ceiling described in subsection (1) above also shall apply to all programs where the State of Ohio or any state department, agency or other state entity is the ultimate payer for the drug, even if it did not purchase the drug directly. This includes, but is not limited to, the Ohio Best Rx Program and the Ohio HIV Drug Assistance Program. In addition to agreements for any cash discounts, free goods, volume discounts, rebates, or any other discounts or credits already in place for these programs, the responsible department, agency or entity shall enter into additional agreements with drug manufacturers for further price reductions so that the net cost of the drug, as determined by the purchasing department, agency or entity, is the same as or less than the lowest price paid for the same drug by the United States Department of Veterans Affairs.
(3) All state departments, agencies and other state entities that enter into one or more agreements with the manufacturer of any drug for the purchase of prescribed drugs or agreement to pay directly or indirectly for prescribed drugs shall implement this section no later than July 1, 2017.
(4) Each such department, agency or other state entity, may adopt administrative rules to implement the provisions of this section and may seek any waivers of federal law, rule, or regulation necessary to implement the provisions of this section.
(5) The General Assembly shall enact any additional laws and the Governor shall take any additional actions required to promptly carry out the provisions of this section.
(E) Liberal Construction.
This Act shall be liberally construed to effectuate its purpose.
If any provision of this Act, or part thereof, or the applicability of any provision or part to any person or circumstances, is for any reason held to be invalid or unconstitutional, the remaining provisions and parts shall not be affected, but shall remain in full force and effect, and to this end the provisions and parts of this Act are severable. If this Act and another law are approved by the voters at the same election with one or more conflicting provisions and this Act receives fewer votes, the non-conflicting provisions of this Act shall go into effect.
(G) Legal Defense.
If any provision of this Act is challenged in court, it shall be defended by the Attorney General of Ohio. The People of Ohio, by enacting this Act, hereby declare that the committee of individuals responsible for the circulation of the petition proposing this Act (“the Proponents”) have a direct and personal stake in defending this Act from constitutional or other challenges. In the event of a challenge, any one or more of the Act’s Proponents shall be entitled to assert their direct and personal stake by defending the Act’s validity in any court of law, including on appeal. The Proponents shall be indemnified by the State of Ohio for their reasonable attorney’s fees and expenses incurred in defending the validity of the challenged Act. In the event that the Act or any of its provisions or parts are held by a court of law, after exhaustion of any appeals, to be unenforceable as being in conflict with other statutory or constitutional provisions, the Proponents shall be jointly and severally liable to pay a civil fine of $10,000 to the State of Ohio, but shall have no other personal liability to any person or entity.
Ignoring inadequate provider networks with 90% inaccuracies!
Complicit with state insurance regulators!
Prices more than doubled in three years, and will rise for three more years!
Instability, uncertainty, sabotage, destroying our healthcare on purpose!
Medicaid insurers taking over the individual market, at rip-off rates!
Healthcare ripped away from 22 million people, 850,000 Ohioans!
Block grants to criminal states with turkey insurance departments!
Eliminating Medicaid expansion and punishing the poor!
Over 50, put out to pasture!
Unethical! Uncivilized! Cruel!
215,000 of Ohio’s 715,000 adults receiving Medicaid through the ACA’s Medicaid expansion are being treated for opioid addiction!
The Ohio Department of Insurance’s director Mary Taylor made a public announcement this month that both her young sons have suffered from opioid addiction. But during all those years that her sons suffered from opioid addiction, she had allowed insurance to be sold with 90% inaccuracies, denying crucial healthcare to Ohioans who bought individual health insurance plans, who could have needed treatment for opioid addiction.
Ohio Senator Rob Portman lobbies for opioid addiction treatment, but ignores the crime of health insurance being sold with inadequate and 90% inaccurate provider networks, denying healthcare to those who buy it, including those who need opioid addiction treatment.
Medicaid block grants going to states, where fools like Mary Taylor, who is running for governor, would have complete control of the money and complete control of Ohioans’ access to healthcare, is dumb, dumb, dumb!
Kasich initiated an expansion of Medicaid, made possible by Obamacare, and has been accepting federal funds to serve an additional 715,000 low-income Ohioans, including roughly 215,000 with drug abuse and addiction issues.
“Right now, Obamacare, including Medicaid, is not sustainable,” Taylor said. “So, the ball is in the court of Washington now. They have to figure out what they’re going to do going forward with regard to any provisions related to Obamacare.”
Anthem is the only insurer right now in 19 Ohio counties, and in 2018 they will be exiting the Ohio individual market, except for one teeny tiny county, Pike, for a non-exchange plan that probably has 5 members, just so they can keep their foot in the door and not be banned for five years in case they want to come back. Awe.
Isn’t a market-driven health care system great.
Anthem has about 18% of the individual market in Ohio, and they insure millions of Ohio corporate and state workers. 40,000 individuals are presently covered by Anthem, and 10,000 people may not be offered any individual plan next year as a result.
In Toledo, Anthem has the worst, smallest provider network, and it was 66% inaccurate. It is highly expensive, and went up quite a bit last year.
Anthem more than tripled their premiums in seven years, just like Medical Mutual did, who removed themselves just this year from insuring an estimated 100,000 covered lives with their PPO plans, thus eliminating the only national network plan sold to individuals in Ohio. Last year two insurers covered nearly 50% of the Ohio individual market, and now they are gone.
Also gone this year is United Healthcare and Aetna, so just like that, our four largest insurers of the individual market are gone from the individual market, and Ohio let them, even rewarding the insurers with our state employee insurance business. Ohio either has no business sense, or our state really doesn’t care whether or not 300,000 Ohioans can buy insurance in the individual market.
Four things that Ohio can do to mitigate this healthcare crisis:
Ohio should do what New York is doing this year, and ban insurers who leave the exchange from any future participation in public programs such as Medicaid.
Ohio should propose a Medicaid buy-in for anyone in the state, like the plan that Nevada’s legislature just passed for it’s citizens. After all, our commercial insurers in the individual market (Anthem, Medical Mutual, United Healthcare, Aetna) have been replaced by Medicaid insurers (Buckeye Ambetter, CareSource, Molina), and since all of Ohio is covered for Medicaid, it makes sense that these insurers can also cover all of Ohio for the individual market, and with great ease.
Ohio should pass an emergency “any willing provider” law so that citizens can take their insurance dollars to any provider willing to accept them and the payment. At an average of 80% inaccuracies in our provider networks, have the worst that have been reported in the entire country! It’s only civilized that Ohio gives us an”any willing provider” law.
Oscar Insurance Corporation of Ohio, a new insurer for Ohio this year, should cover all the counties that Anthem has left hanging.
But they won’t be covering even one of them. It comes to Ohio to set up shop with Cleveland Clinic in the five counties around Cleveland.
It’s a perfect example to show why market-driven health insurance does not jive with societal needs, and it never will.
(Dream on, hoping for a private, for-profit insurance industry to voluntarily go into 19 counties for the business of a mere 10,000 people who won’t otherwise have insurance, when the company can get the same business by simply marketing to the east side of Cleveland. But for some reason, the for-profit, so called “free market” health insurance model persists. And it has nothing to do with what is best for our country.)
Here’s something the federal government can do: Open up the D.C. Exchange to people without an option, as per U.S. Senator Claire McCaskill’s proposal.
The D.C. Exchange sells insurance for everyone in the country, that is, everyone who is a member of Congress or their staff. I have researched the plans and found that they are really inexpensive compared to what is sold in Ohio. Moreover, it’s quality PPO insurance with national provider networks.
At one time, the ACA was going to have just one exchange for the entire country, like this exchange in D.C. But then the insurers got their mitts on the shaping of the ACA. They sliced it up into hundreds of different state and county plans. Four short years later, insurers are leaving, and hundreds of counties will have no insurance option. It seems logical to open up the D.C. exchange, for everyone. What would be wrong with doing that?
On a final note, the chart below shows the three largest insurers in Ohio, from a report made to the state of Ohio by the actuarial company, Milliman, in 2011. I added to the original chart in light blue, to show the individual rate increases since 2010. (The dark blue along with the red and green show the 2010 rates.)
With the withdrawal of Anthem, none will be in the individual market next year! Our three biggest insurers in the individual market in 2010, gone!
It’s no wonder, because our regulators let their rates go up over 300% in 7 years, while the rates for the group plans went up only a total of 30%. Wow. You’d think that all the new members of these plans had leprosy. I hope they are cured, at least.
Divide, divide, divide. Divide and subtract some more! The huge free market health insurance system is so close to knocking off those 23 million people who just don’t fit in their money-making calculations.
Click on the crowns to read about my representatives. I’m deeply disappointed that they won’t fix the problems that are completely in their control to fix right now, like the highly inaccurate provider networks, and the transparency that the ACA provided for that they won’t abide by, and that they won’t pass an emergency “any willing provider” law so I can take my insurance dollars to my own doctor, and I’m shocked that when they say they are going to give us something better than the ACA, that they only think of the insurance industry, still putting profits over people. King Moola rules. Please, mini Moolas, please please throw us some crumbs!
If you are going to let yourself be crowned by the lobbyists, at least understand the concept of noblesse oblige. It’s like this: the masters must be responsible for those they tame.
Enforcing [directory-accuracy rules] is “consumer-driven,” said David Hopcraft, a spokesman for the Ohio Insurance Department. The state does not check the lists until consumers report inaccuracies, one doctor at a time.
This is my great great grandfather’s photo of the Kickapoo Indian Medicine Company.
The Kickapoo Indian Medicine Company, of New Haven, Connecticut, sold “patent medicine” before they had patents for medicine. They sold snake oil when it was the cure-all. They weren’t really Indian. Kickapoo Medicine was often laced with alcohol, morphine, opium, or cocaine.
knowing that he’s a member of the “Freedom Caucus”
Congressmen are supposed to be concerned with the wellbeing of the people in the state to which they serve. But U.S. Representative Jim Jordan went out of his way to make uncaring comments on the report of Ohio’s highly inaccurate provider networks by Kaiser Health News and the New York Times, and how Ohio’s inaccuracies are the worst in the country, and that the state insurance department does nothing to fix the problem.(New York Times, December 4, 2016, Insurers’ Flawed Lists Send Patients Scrambling)
“It should surprise no one that the Ohio Department of Insurance’s physician directories are so flawed, considering how flawed the Affordable Care Act (ACA) is.”
“It’s sadly no surprise that the doctors’ lists were flawed as well,” Rep. James “Jim” Jordan (R-OH) said during a Patient Daily email interview. “Health care will be better and more affordable when Obamacare is gone.”
The Ohio Department of Insurance does not have physician directories, the insurance companies do, so Congressman Jim Jordan doesn’t know what he’s talking about. Yet he feels compelled to blame the ACA for it. The ACA has nothing whatsoever to do with the phony provider network directories of the health insurance companies that sell plans through the Marketplace.
U.S. Representative Jim Jordan’s ignorance notwithstanding, honestly, how can a U.S. Representative go on record saying that the 80% inaccuracies are not surprising? Has he no sense of right and wrong? Has he no empathy for his constituents and neighboring citizens of Ohio? 80% is a devastating percentage of a provider network to be found inaccurate. It happens to be the worse percentage of any survey yet reported from any state in the United States. Ohioans are hurting, and Rep. Jim Jordan is not helping!
Provider network directories are regulated by the state of Ohio and have existed long before Obamacare. Most other states have accurate physician directories that people who are looking to buy insurance can use to properly assess the health insurance networks and find doctors who are accepting new patients like the list says. Many states have strict laws concerning the accuracy of their lists, and if the lists say they are accepting new patients, they are accepting new patients, and not just 20% of the list, as I have proven in Toledo.Ohio does not have strict provider network directory laws and what little regulation the insurance companies have, is regulated by the Ohio Department of of Insurance, which is just like being regulated by the insurance company itself.